RN Navigator Leadership Position in Healthcare

5 days ago


San Antonio, Texas, United States CHRISTUS Health Full time
Job Title: RN Navigator Leadership Position

An exciting opportunity has arisen for a Registered Nurse to assume a leadership role in our healthcare team.

About the Role:

The RN Navigator Lead will provide health and wellness coaching, case management services, and analysis of data regarding CHRISTUS Health services. This position involves monitoring cases and claims, analyzing biometric and health risk assessment data, organizing disease management programs, and proactively interacting with members, physicians, and other providers.

The successful candidate will oversee an integrated data warehouse, including program utilization, disease management programs, and contracted provider network support. They will also establish a system for coordinating patient care throughout the continuum of care.

Responsibilities:
  • Develop and implement an integrated medical benefit program, including case management and health/disease management.
  • Establish a coordination system for patients' care throughout the continuum of care.
  • Utilize standard tools, databases, and methodologies to support the health benefit program and lead in managing cases, events, and diseases determined by Senior Management as targeted priorities.
  • Interact with providers and plan members in case management medical activities to deliver efficient and effective service.
  • Identify targeted chronic diseases/high-risk individuals (with vendor support) and develop programs to reduce financial and health risks using internal hospital programs/services whenever possible.
  • Monitor and evaluate the impact of case management on the patient population.
  • Create outcomes-management focus through interdisciplinary analysis of clinical, financial, and satisfaction elements for the patient population.
  • Assist in analyzing demographics, utilization, and reimbursement.
  • Prepare cost analyses and reports to assess reasonableness of claim/cost data and utilization rates.
  • Make recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, out-of-pocket expenses, etc. to contracted employer groups.
  • Maintain consistent attendance, punctuality, and personal appearance according to CHRISTUS Health attendance and dress code policies.
  • Promote organizational values by treating others with respect, keeping commitments, and working ethically and with integrity.
  • Attend meetings as required and participate in team activities, demonstrating confidence, motivation, and inspiration.
  • Establish and maintain effective relationships with team members, patients, and the public through verbal and written communication, responding clearly and effectively.
  • Demonstrate ability to read and respond to emails and appointment requests in a timely manner and regularly.
  • Use time efficiently, plan for additional resources, set goals, and objectives, and work in an organized manner.
  • Demonstrate safety practices and maintain a safe environment for patients, visitors, and fellow team members by following established safety and infection control standards.

$65,000 - $80,000 per year (dependent on experience)



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